Cross-Cultural Perspectives on Facial Aging

Image Credit: © Alessandro Grandini - stock.adobe.com

The periorbital region is one of the first areas to show visible signs of aging, often manifesting as under-eye wrinkles, dark circles, and crow’s feet.¹ These changes are driven by both intrinsic factors, such as collagen degradation and loss of skin elasticity, and extrinsic factors, including sun exposure and environmental pollutants.² A recent study investigated how these age-related changes in the periorbital region impact perceptions of age, health, and attractiveness across 5 ethnic groups.³ Understanding these associations is critical for clinicians seeking to address patient concerns regarding periorbital aging through both preventative and corrective interventions.

Methods

This study analyzed facial images of 180 women from 5 ethnic backgrounds (Chinese, Japanese, French, Indian, and South African) using digital imaging techniques to quantify periorbital skin characteristics. Each participant’s facial image was assessed by 120 raters from the same ethnic group to determine perceived age, health, and attractiveness. The study focused on 2 facial regions: under the eyes, where color, gloss, tone evenness, and wrinkles were measured, and the crow’s feet region, where wrinkle density, length, and volume were evaluated. The collected data were statistically analyzed to determine the predictive value of these features on facial perception across different ethnic groups.

Results

The study’s findings indicate significant ethnic differences in periorbital skin characteristics, particularly in wrinkle density, skin color, and gloss. Researchers statedSouth African and Indian women exhibited lower skin lightness and greater wrinkle volume under the eyes compared to other groups, while Japanese and French women displayed less pronounced wrinkles in the crow’s feet region.

Across all ethnicities, wrinkles were found to be the strongest predictors of perceived age, health, and attractiveness. The study states, “Wrinkles under the eyes and crow’s feet correlated negatively with age, health, and attractiveness in the full sample.” This underscores the universal impact of periorbital wrinkles on facial aesthetics. Additionally, skin gloss was found to be an important factor in health perception, as “higher skin gloss was associated with improved health ratings.” These findings align with previous literature highlighting the role of periorbital changes in perceived facial aging.

Discussion

The study’s results provide valuable insights into the management of periorbital aging. Given that crow’s feet and under-eye wrinkles are primary determinants of perceived age and attractiveness, targeted interventions such as botulinum toxin injections, dermal fillers, and energy-based devices (e.g., fractional lasers and radiofrequency treatments) may offer significant aesthetic benefits. Additionally, skin gloss and tone evenness were found to influence perceived health, suggesting a role for topical agents such as retinoids, antioxidants, and hyaluronic acid-based treatments in improving periorbital skin quality.

It is also notable that while ethnic variations exist in periorbital skin characteristics, the impact of these features on facial perception remains consistent across groups. This reinforces the need for clinicians to adopt a personalized yet universal approach when addressing periorbital aging concerns.

Conclusion

This study highlights the importance of under-eye skin and crow’s feet in the perception of facial aging, health, and attractiveness across diverse populations. The predictive role of wrinkles in these perceptions aligns with patient concerns about periorbital aging and underscores the need for targeted interventions. The study suggested that clinicians should consider both structural and surface-level treatments to address periorbital aging effectively, with a focus on maintaining skin elasticity, improving tone evenness, and minimizing wrinkle formation. Researchers stated future research should explore the long-term efficacy of various therapeutic modalities in managing periorbital aging and their impact on patient satisfaction and self-perception.

References

1. Fabi S, Alexiades M, Chatrath V, et al. Facial aesthetic priorities and concerns: A physician and patient perception global survey. Aesthet Surg J. 2022;42(4):NP218-NP229. doi:10.1093/asj/sjab358
2. Kligman AM, Zheng P, Lavker RM. The anatomy and pathogenesis of wrinkles. Br J Dermatol. 1985;113(1):37-42. doi:10.1111/j.1365-2133.1985.tb02042.x
3. Fink B, Campiche R, Shackelford TK, Voegeli R. Effects of under-eye skin and crow's feet on perceived facial appearance in women of five ethnic groups. Int J Cosmet Sci. 2025. doi:10.1111/ics.13045